MEDICARE: HOSPITAL OF SAINT RAPHAEL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA0600X	Adult Day Care Clinic/Center		CT

General Provider Information

NPI Number	:	1033391594
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOSPITAL OF SAINT RAPHAEL

Provider Business Mailing Address
First Line	:	196 PARK ST APT 7
Second Line	:
City	:	NEW HAVEN
State	:	CT
Zip	:	06511-4761
Country	:	US
Telephone Number	:	203-278-2915
Fax Number	:

Provider Business Practice Location Address
First Line	:	196 PARK ST APT 7
Second Line	:
City	:	NEW HAVEN
State	:	CT
Zip	:	06511-4761
Country	:	US
Telephone Number	:	203-278-2915
Fax Number	:

Authorized Official
Title or Position	:	PGYI
Name	:	WALID LABIB SHAIB
Credential	:	M.D.
Telephone Number	:	203-278-2915

Provider Enumeration Date	:	11/27/2007
Last Update Date	:	11/27/2007

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